HomeMy WebLinkAboutXR2023-0599 - Permit ApplicationPrint Form
I_ _ I Worksheet for Combo Building & Solar Permit Application
rXomm'I FkXesidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address
Description of Work Gv'A--per
New/Add SFF —
OWNER'S NAME
Owner's Address
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F- Flood ( Fire I- Liq r Landslide FN/A Floor
Suite No
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# Stories F
/1.� � #Units (if Res)I �^
Garage/New/Add �— Valuation $ Material/Labor // C� / ) 0,
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Last . %yG First _
Owner's E-mail Address
City tate
APPLICANT'S NAME Last
Applicant's Address
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ARCHITECT/DESIGNER'S NAME
Last %Z,6,n/1 J�, /
Zip TelephoneF —
First ✓A
Applicant's E-mail Address
zip %G�1Z Telephone
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First 7/1 %U o/ Lic. No 2�
Architect/Designer's Address Architect/Designer's E-mail Address
City State �— 7_ '—
- Zip
ENGINEER'S NAME Last
First
Engineer's Address
Engineer's E-mail Address
City®®® State �® Zip [ Telephone
CONTRACTOR'S NAME/COMPANY
Contractor's Address
Lic.
Lic. No. FVZq3 Class
Contractor's E-mail Address
City I State — -
ZiP 7— TelephoneF�
SETBACKS REAR SETBACKS FRONT PERMIT NO. X' v (,OZ)2 l (Y�Il q
SETBACKS LEFT SETBACKS RIGHT u
USE ZONE PLAN CHECK NO. �L
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